The recent scandal involving patient neglect in the NHS in England has focused attention on healthcare staff behaviours and attitudes. A range of research studies and government reports have surveyed staff attitudes and experiences of neglect, but little research specifically on the nature, frequency and causes of hospital neglect. This paper aims to fill this gap.
Neglect is defined as failing to provide basic care, e.g. not washing a patient, turning them often enough to prevent the development of bed sores or assisting with eating and drinking. A key concern is that it may reflect a lack of compassion and care by healthcare staff towards patients. Research has also indicated that, whilst healthcare staff might feel that they are caring for their patients, they may not actually be. This has led to a term called ‘caring neglect’ which is distinct from the more objectively measured, proceduralised definition of neglect e.g. failure to wash or turn a patient but which is seen by patients, families and colleagues as indicative of a lack of care by healthcare staff.
In contrast to the ‘procedural’ neglect investigated in the LA Hospital Neglect literature which can be caused by error or a lack of skill there is also a growing body of work on ‘caring neglect’, which is more subjective and can have a damaging impact on the emotional health of patients and their relatives. ‘Caring neglect’ is usually captured by observing a range of healthcare staff behaviours, including ignoring a patient, rudeness and a general lack of urgency in providing assistance with activities such as dressing and toileting. Such behaviours are not necessarily violations of institutional procedures and can occur for a range of reasons, such as staff not having time to assist patients because they are too busy or not being given the training and support they need.
Despite the importance of these issues, the research on patient neglect is fragmented and largely inconclusive. This may be due to the difficulty of measuring neglect and a reluctance of some staff to report instances of it. In addition, the solutions that have been proposed to address instances of neglect often appear contradictory e.g. reducing bureaucracy to free up time to care, yet increasing staffing levels to ensure that people are not neglected or involve regulating aspects of staff behaviours which cannot be easily monitored or measured e.g. compassion.
Despite the limitations of existing evidence, the current review suggests that there is a strong case for further research into the factors that lead to neglect, particularly its effects on patients. This would include investigating the potential for interventions such as team-training and re-designing care bundles to reduce the occurrence of neglect and its consequences. In addition, future modelling of the causes and outcomes of neglect should integrate a psychological model which incorporates the impact of factors relating to staff attitudes as well as those relating to organisational processes and systems such as poor communication training and failures in clinical processes.